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  • ABOUT C.H.A.N.G.E.
    • THE C.H.A.N.G.E MANTRA
    • Founders' Passion
  • Programs
  • Volunteer
  • Contact Us/inquiries

    Leadership Program Application (July 29-31, 2014)  Elizabeth City, NC 
    . 

    Please indicate your t-shirt size.

    Parent/Guardian Information

    If you do not have an e-mail address, please input the following: [email protected]
    The Overnight Option is highly encouraged, but not required.
    Limited Sponsorships for Lodging costs may be available. 
    Contact [email protected] or Dr. Jametta Davis at 703-899-0482
    Check All that Apply

    Adult Recommendation (Family Member, Family Friend, Community Leader, etc)

    Adult Recommendation can be a Family Member, Community Leader, etc.
    If the answer is no, please write N/A. If the answer is yes, please explain the behavioral issue(s) here.

    All Applicants Must Complete This Section

    List your hopes, dreams, desires, or even your summer or academic goals. We just want to know more about you!
    We want to know more about you so we can tailor the workshop, so come on tell us a little about YOU!
    There are no right or wrong answers here. Just write what you think.
    There is no minimum or maximum number of words for your response. Please answer this question to the best of your ability.
    Applications can be submitted by pressing the button below, if you make an error or need to amend the application, please e-mail us at [email protected] or contact the Elizabeth City Program Director (information below).
    Program Director:
    Melba Smith, 252-335-3985,  [email protected]
Submit
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